The effects of prenatal outreach and nurse-coordinated care / Melinda L. Jenkins.

Jenkins, Melinda L.
x, 167 leaves : ill. ; 29 cm.
Medical subjects:
Dissertations, Academic.
Local subjects:
Penn dissertations -- Nursing. (search)
Nursing -- Penn dissertations. (search)
The effects of lay outreach on access to prenatal care were evaluated in an African American inner-city population. Lay workers provided door-to-door casefinding and follow-up with material aid, emotional support, and social service referrals in a neighborhood at high risk for infant mortality. The study, based on the conceptual framework of access to health care developed by Aday and Andersen (1981), employed a comparison group design. The sample consisted of consecutive patients registered at the intervention health center (n = 111), and an adjoining health center without the intervention (n = 122). In both sites, nurse practitioners provided the publically funded prenatal care and coordinated with related social services. Data from prenatal questionnaires and prenatal and delivery records revealed that the intervention and comparison groups were similar in age, education, past pregnancies, past premature deliveries, and prenatal hemoglobin. Tobacco and cocaine use were significantly greater in the intervention group. In the casefinding area, 41 more women than expected began prenatal care (X$\sp2$ = 35.47, df = 1, p $<$.001). The intervention group received more childcare during clinic visits and more permanent housing and had greater satisfaction with care. No significant differences were found between the intervention and the comparison groups in barriers to prenatal care, number of prenatal visits, total social services received, birth weight, estimated gestational age, or baby's and mother's length of hospital stay. The comparison group began care an average 3.5 weeks earlier than the intervention group. Barriers were not related to use of care, satisfaction, or health outcomes. Records reviewed for women without prenatal care from both neighborhoods (n = 72, 76) showed they were similar to the prenatal care groups in age and education but had significantly greater past pregnancies, past premature deliveries, and tobacco and cocaine use. Their infant outcomes were significantly worse. Confirming previous studies, lay outreach was effective in increasing prenatal care enrollment by 11% and increasing satisfaction among enrollees while maintaining infant outcomes equivalent to a group with earlier enrollment and lower cocaine and tobacco use.
Supervisor: Linda H. Aiken.
Thesis (Ph.D. in Nursing) -- Graduate School of Arts and Sciences, University of Pennsylvania, 1993.
Includes bibliographical references.
Local notes:
University Microfilms order no.: 93-21410.
Aiken, Linda H., advisor.
University of Pennsylvania.
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